Skip to main content
SpringerLink
Log in

Microsurgery Essentials: Preconditions, Instrumentation, and Setup

  • Chapter
  • First Online:
Core Techniques in Flap Reconstructive Microsurgery

Abstract

Microsurgery allows the surgical intervention of submillimeter vessels and peripheral nerves leading to improved treatment possibilities of thousands of patients each year. Due to enhanced visualization and improved precision, it has become a fundamental part of the reconstructive surgeon’s arsenal. Over the past decades, it is routinely practiced in most major medical centers. In this chapter, after a brief historical introduction, we present the main methods for surgical magnification (loupes and microscopes) and describe the microsurgical equipment, instruments, and sutures together with the needs and possibilities related to microsurgical training.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Carrel A. La technique opératoire des anastomoses vasculaires et de la transplantation des visceres. Lyon: Association Typographique; 1902.

    Google Scholar 

  2. Nylen CO. The microscope in aural surgery, its first use and later development. Acta Otolaryngol Suppl. 1954;116:226–40.

    Article  CAS  PubMed  Google Scholar 

  3. Jacobson JH, Suarez EL. Microsurgery in anastomosis of small vessels. Surg Forum. 1960;11:243–5.

    Google Scholar 

  4. Malt RA, McKhann C. Replantation of severed arms. JAMA. 1964;189:716–22.

    Article  CAS  PubMed  Google Scholar 

  5. Buncke HJ, Buncke GM, Kind GM. The early history of microsurgery. Plast Reconstr Surg. 1996;98(6):1122–3.

    Article  CAS  PubMed  Google Scholar 

  6. McLean DH, Buncke HJ Jr. Autotransplant of omentum to a large scalp defect, with microsurgical revascularization. Plast Reconstr Surg. 1972;49(3):268–74.

    Article  CAS  PubMed  Google Scholar 

  7. Troutman RC. The operating microscope in ophthalmic surgery. Trans Am Ophthalmol Soc. 1965;63:335–48.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. La Rocca G, Della Pepa GM, Menna G, Altieri R, Ius T, Rapisarda A, et al. State of the art of fluorescence guided techniques in neurosurgery. J Neurosurg Sci. 2019;63(6):619–24.

    PubMed  Google Scholar 

  9. Stanbury SJ, Elfar J. The use of surgical loupes in microsurgery. J Hand Surg [Am]. 2011;36(1):154–6.

    Article  Google Scholar 

  10. Baker JM, Meals RA. A practical guide to surgical loupes. J Hand Surg [Am]. 1997;22(6):967–74.

    Article  CAS  Google Scholar 

  11. Mendez BM, Chiodo MV, Vandevender D, Patel PA. Heads-up 3D microscopy: an ergonomic and educational approach to microsurgery. Plast Reconstr Surg Glob Open. 2016;4(5):e717.

    Article  PubMed  PubMed Central  Google Scholar 

  12. De Virgilio A, Costantino A, Ebm C, Conti V, Mondello T, Di Bari M, et al. High definition three-dimensional exoscope (VITOM 3D) for microsurgery training: a preliminary experience. Eur Arch Otorhinolaryngol. 2020;277(9):2589–95.

    Article  PubMed  Google Scholar 

  13. Pafitanis G, Hadjiandreou M, Alamri A, Uff C, Walsh D, Myers S. The exoscope versus operating microscope in microvascular surgery: a simulation non-inferiority trial. Arch Plast Surg. 2020;47(3):242–9.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Uson J, Calles MC. Design of a new suture practice card for microsurgical training. Microsurgery. 2002;22(8):324–8.

    Article  PubMed  Google Scholar 

  15. Lausada NR, Escudero E, Lamonega R, Dreizzen E, Raimondi JC. Use of cryopreserved rat arteries for microsurgical training. Microsurgery. 2005;25(6):500–1.

    Article  PubMed  Google Scholar 

  16. Olabe J. Microsurgical training on an in vitro chicken wing infusion model. Surg Neurol. 2009;72(6):695–9.

    Article  PubMed  Google Scholar 

  17. Chen WF, Eid A, Yamamoto T, Keith J, Nimmons GL, Lawrence WT. A novel supermicrosurgery training model: the chicken thigh. J Plast Reconstr Aesthet Surg. 2014;67(7):973–8.

    Article  PubMed  Google Scholar 

  18. Pafitanis G, Serrar Y, Raveendran M, Ghanem A, Myers S. The chicken thigh adductor profundus free muscle flap: a novel validated non-living microsurgery simulation training model. Arch Plast Surg. 2017;44(4):293–300.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Shurey S, Akelina Y, Legagneux J, Malzone G, Jiga L, Ghanem AM. The rat model in microsurgery education: classical exercises and new horizons. Arch Plast Surg. 2014;41(3):201–8.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Pafitanis G, Narushima M, Yamamoto T, Raveendran M, Veljanoski D, Ghanem AM, et al. Evolution of an evidence-based supermicrosurgery simulation training curriculum: a systematic review. J Plast Reconstr Aesthet Surg. 2018;71(7):976–88.

    Article  PubMed  Google Scholar 

  21. Zheng Y, Corvi JJ, Nicolas CF, Akelina Y. Supermicrosurgery simulation training program for submillimeter anastomoses in the rat epigastric artery and vein. Microsurgery. 2019;39(8):773–4.

    Article  CAS  PubMed  Google Scholar 

  22. Najjar M, Lopez MM Jr, Ballestin A, Munabi N, Naides AI, Noland RD, et al. Reestablishment of lymphatic drainage after vascularized lymph node transfer in a rat model. Plast Reconstr Surg. 2018;142(4):503e–8e.

    Article  CAS  PubMed  Google Scholar 

  23. Yamamoto T, Yamamoto N, Yamashita M, Furuya M, Hayashi A, Koshima I. Establishment of supermicrosurgical lymphaticovenular anastomosis model in rat. Microsurgery. 2017;37(1):57–60.

    Article  PubMed  Google Scholar 

  24. Bodin F, Diana M, Koutsomanis A, Robert E, Marescaux J, Bruant-Rodier C. Porcine model for free-flap breast reconstruction training. J Plast Reconstr Aesthet Surg. 2015;68(10):1402–9.

    Article  PubMed  Google Scholar 

  25. Gonzalez-Garcia JA, Chiesa-Estomba CM, Alvarez L, Altuna X, Garcia-Iza L, Thomas I, et al. Porcine experimental model for perforator flap raising in reconstructive microsurgery. J Surg Res. 2018;227:81–7.

    Article  PubMed  Google Scholar 

  26. Gonzalez-Garcia JA, Chiesa-Estomba CM, Larruscain E, Alvarez L, Sistiaga JA. Porcine experimental model for gracilis free flap transfer to the head and neck area with novel donor site description. J Plast Reconstr Aesthet Surg. 2020;73(1):111–7.

    Article  PubMed  Google Scholar 

  27. Nistor A, Ionac M, Spano A, Georgescu A, Hoinoiu B, Jiga LP. Mastering the approach of internal mammary vessels: a new training model in pigs. Plast Reconstr Surg. 2013;131(5):859e–61e.

    Article  CAS  PubMed  Google Scholar 

  28. Tolba RH, Czigany Z, Osorio Lujan S, Oltean M, Axelsson M, Akelina Y, et al. Defining standards in experimental microsurgical training: recommendations of the European Society for Surgical Research (ESSR) and the International Society for Experimental Microsurgery (ISEM). Eur Surg Res. 2017;58(5–6):246–62.

    Article  PubMed  Google Scholar 

  29. Ghanem A, Kearns M, Ballestin A, Froschauer S, Akelina Y, Shurey S, et al. International microsurgery simulation society (IMSS) consensus statement on the minimum standards for a basic microsurgery course, requirements for a microsurgical anastomosis global rating scale and minimum thresholds for training. Injury. 2020;51(Suppl 4):S126–S30.

    Article  PubMed  Google Scholar 

  30. Ghanem AM, Al Omran Y, Shatta B, Kim E, Myers S. Anastomosis Lapse Index (ALI): a validated end product assessment tool for simulation microsurgery training. J Reconstr Microsurg. 2016;32(3):233–41.

    PubMed  Google Scholar 

  31. Oltean M, Nistor A, Hellstrom M, Axelsson M, Yagi S, Kobayashi E, et al. Microsurgery training during COVID-19 pandemic: practical recommendations from the International Society for Experimental Microsurgery and International Microsurgery Simulation Society. Microsurgery. 2021;41(4):398–400.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Santamaria E, Nahas-Combina L, Altamirano-Arcos C, Vargas-Flores E. Master Series microsurgery for residents: results from a comprehensive survey of a multitudinous online course during COVID-19 pandemic. J Reconstr Microsurg. 2021;37:602.

    Article  PubMed  Google Scholar 

  33. Kwon SH, Goh R, Wang ZT, Ting-Hsuan Tang E, Chu CF, Chen YC, et al. Tips for making a successful online microsurgery educational platform: the experience of international microsurgery club. Plast Reconstr Surg. 2019;143(1):221e–33e.

    Article  CAS  PubMed  Google Scholar 

  34. Shurey S. MicroShure microsurgery. YouTube. 2020. https://www.youtube.com/channel/UCytdJXQfxRijsyJRRPai1jg.

  35. Loh CY, Tiong VT, Loh AY, Athanassopoulos T. Microsurgery training--a home do-it-yourself model. Microsurgery. 2014;34(5):417–8.

    Article  PubMed  Google Scholar 

  36. Kim DM, Kang JW, Kim JK, Youn I, Park JW. Microsurgery training using a smartphone. Microsurgery. 2015;35(6):500–1.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Tumor Microenvironment Laboratory, Institut Curie, Paris, France

    Alberto Ballestín

  2. MicroShure Ltd, Brixham, England, UK

    Sandra Shurey

Authors
  1. Alberto Ballestín
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sandra Shurey
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Plastic, Reconstructive and Aesthetic Surgery, Royal Free Hospital & University College London (UCL) Division of Surgical Sciences, London, UK

    Dariush Nikkhah

  2. Department of Plastic Surgery, Royal Perth Hospital, Perth, WA, Australia

    Jeremy Rawlins

  3. London Reconstructive Microsurgery Unit (LRMU), Department of Plastic Surgery, Emergency Care and Trauma Division (ECAT), The Royal London Hospital, Barts Health NHS Trust & University College Hospital London (UCLH), London, UK

    Georgios Pafitanis

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Ballestín, A., Shurey, S. (2023). Microsurgery Essentials: Preconditions, Instrumentation, and Setup. In: Nikkhah, D., Rawlins, J., Pafitanis, G. (eds) Core Techniques in Flap Reconstructive Microsurgery. Springer, Cham. https://doi.org/10.1007/978-3-031-07678-7_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-07678-7_1

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-07677-0

  • Online ISBN: 978-3-031-07678-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation